Case Study: How Direct Patient Insights Empower Providers to Improve Quality Performance
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Converged Risk
Ensure compliance with advanced analytics and flexible member engagement solutions enabling efficient and accurate documentation of member conditions.
Powered by the Inovalon ONE® Platform
Over 15 years of industry experience and expertise empowering health plans across all lines of business to achieve risk score accuracy.
Overview
Inovalon delivers a scalable, end-to-end risk score accuracy solution that can be tailored to meet your unique program needs. We work with you to design a program that ensures the accuracy of your members’ risk scores.
Predictive Analytic Insights
Create your own cohorts and run predictive gap identification and intervention planning analytics on-demand to identify and address emerging and suspected patient-specific diagnoses.
Data-Driven Intervention Planning and Execution
Implement proven education and multi-channel intervention strategies and solutions that support a more comprehensive patient assessment and accurate disease and comorbidity burden documentation.
Compliant, Accurate Regulatory Submissions
Proactively manage claims processing at various stages throughout the submissions process and monitor the financial impact of claims in error or not submitted to ensure accurate and timely submissions.
Benefits
Improve risk score accuracy with machine learning-trained analytics that leverage historical data, trends, and past performance to identify member diagnoses that may be incompletely or improperly reflected within claims data systems and abstracted medical records.
Unparalleled Data Assets and Analytics
Gain insights informed by data for more than 361 million patients, enabling effective documentation gap closure and informed strategic decision making.
In-Office Clinical Documentation Support
Leverage Inovalon’s Converged Patient Assessment software to deliver claims history and member-specific gaps at the point of care to improve disease documentation and risk score accuracy.
Seamless Member Experiences
Access deep member insights to drive highly-targeted, tailored interventions that offer members flexibility and choice to select the right encounter venue for them.
Regulatory and Compliance Expertise
Inovalon has over 15 years of policy, regulatory compliance, and clinical experience to deliver expert program oversight and ensure compliant program execution.
How it Works
Maximize risk score accuracy and ensure accurate financial performance with a comprehensive, end-to-end solution or one tailored to supplement your current program.
Accurate Analytics. Seamless Member Experiences.
Converged Risk leverages Inovalon’s industry-leading data assets and advanced analytic capabilities to improve member and provider experience, disease documentation, and coding accuracy while ensuring compliant program execution.
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- Identify, pursue, and document valid diagnoses via EHR interoperability or clinical data extraction, as well as traditional paper-based medical record retrieval
- Customize target hierarchical condition categories based on unique membership characteristics and data elements
- Predict emerging patient-specific diagnoses and drive highly targeted, patient-centric interventions
- Access service or software solutions to ensure complete, accurate, and compliant submissions – on-time, every time
Real-World Applications
Inovalon’s offers a custom experience – via an intuitively designed user interface – by combining secure user roles with access to real-time reporting, 24/7/365, on any device.
Predictive HCC gap analysis
Seamlessly stratify entire populations based on patient conditions and confidence thresholds, with metrics such as risk score opportunity, trend, forecasting, and recapture rates.
Financial forecasting
Prioritize and allocate resources, in-year, based on forecasted PMPY impact by HCCs, population and/or demographic segmentation, providers, and more.
Interactive worklists
Create tailored worklists by quickly identifying, researching, and exporting member and provider level details across entire populations.
Converged Risk Add-ons
Converged Analytics Designer
Design and share custom measure strategies to advance priority healthcare initiatives for improved outcomes and performance.
Converged Data Insights
Reduce the burden of manual and ad-hoc reporting with versatile, purpose-built software for health plan data management initiatives – all while gaining a more comprehensive view.
Converged Encounter Submissions
Deliver complete, accurate, secure submissions, on-time and with fewer errors for Medicare EDS and ACA EDGE Server.
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Resources
Payer Resources
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